Monday, August 6, 2012

VAOS 4: Pediatric Ophthalmology June 2012-- Friendship and professional exchanges

Special report by: Ms Maggie O'Hara

Visiting Specialists
Dr. Mary A. O’Hara, M.D.
Professor, UC Davis Department of Ophthalmology and Vision Sciences
Associate Professor, Uniformed Services University of Health Sciences Department of Surgery
Director, UC Davis Eye Center (Pediatric Ophthalmology and Strabismus)
American Board of Ophthalmology
American Academy of Ophthalmology
American Academy of Pediatric Ophthalmology and Strabismus

Dr. Michael Pi, M.D.
Medical Director, Surgicare of Hawaii
American Board of Anesthesiologists
American Society of Anesthesiologists
Society of Pediatric Anesthesiology

Dr. Hai H. Tong, O.D.
Pediatric Optometrist, UC Davis Eye Center
Residency Instructor, UC Davis, Department of Ophthalmology; 
Clinical optics, refraction, and binocularity
California State Board of Optometry License
American Academy of Optometry

Dr. Larisa M. Johnson-Tong, O.D., FAAO
Clinical Optometrist, UC Davis Eye Center
Residency Instructor, UC Davis, Department of Ophthalmology; 
Clinical optics, refraction, and contact lens fitting
California State Board of Optometry License
American Academy of Optometry

In June 2012, four American eye specialists traveled to Vietnam for the 4th Joint Vietnamese American Ophthalmology Symposium. This symposium focused on the specialty of pediatric ophthalmology, and the American visitors were able to share their expertise on a variety of subjects, such as diagnoses, surgical techniques, anesthesia, and optometry. The experience was an opportunity for members of two cultures to collaborate with and learn from each other while providing premiere eye care to local patients and their families.

Wednesday, June 13, American Eye Center Viet Nam
Dr. Mary O’Hara, director of Pediatric Ophthalmology and Strabismus at the University California Davis Eye Center, saw four pediatric patients at the American Eye Center. This modern facility in Ho Chi Minh ,  directed by VAOS organizer Dr. Nam Tran Pham, provides a variety of ophthalmic services, such as children’s eye care, eyelid surgery, contact lenses and glasses, LASIK, and treatment for presbyopia, diabetic eye disease, and glaucoma.

Dr. O’Hara looked at a variety of patients with cases including congenital cataracts  and Duane’s syndrome. Throughout each case, she offered advice to Dr. Pham and to the parents about what the next steps in treatment should be.

Thursday, June 14: Ho Chi Minh City Eye Hospital

Dr. Nam Tran Pham, Dr. Mary O’Hara, Dr. Michael Pi, Dr. Hai Tong, and Dr. Larisa Johnson-Tong visited the HCMC Eye Hospital for a full day of seeing young patients and preparing for Friday’s surgeries. They were assisted by Ms. Ashley Le, a clinical nurse from Hawaii, and Ms. Maggie O'Hara.

In the afternoon, as Dr. Johnson-Tong and Dr. Tong met with patients needing contact lens and other optometry care, Dr. O’Hara and Dr. Pi were in the operating room looking at pediatric cases in preparation for the surgeries scheduled for the next day. Each American doctor was surrounded by a group of Vietnamese doctors, who eagerly asked questions and followed along as the American visitors explained treatment options


Friday, June 15: Ho Chi Minh City Eye Hospital

Friday was another long day at the eye hospital, and again the American visitors were split between the operating room and the optometry department. With Dr. Pi working with the anesthesiologists and Dr. O’Hara working with surgeons, the group performed four surgery cases. The surgeries were projected live to the hospital auditoriumfor viewing by  more Vietnamese physicians in the hospital, who asked questions via microphone throughout the procedures.

The four cases were:
1. 3 year-old boy
Diagnosis: Double elevator palsy
Procedure: Transposition of left lateral rectus and medial rectus muscles

2. 6 year old girl
Diagnosis: Esotropia 35 PD, dissociated vertical deviation, Inferior oblique overaction
Procedure: Bilateral medial rectus recession 5mm, Bilateral anterior transposition of inferior oblique muscles

3. 13 year-old girl
Diagnosis: Dissociated vertical deviation both eyes
Procedure: Bilateral anterior transposition of inferior oblique muscles

4. 15 year-old girl
Diagnosis: Left superior oblique palsy with hypertropia 25 PD
Procedure: Right inferior rectus recession 5mm, Left inferior oblique recession

Dr. Michael Pi worked closely with hospital anesthesiologists on Pediatric general anesthesia techniques.

Dr O'Hara also examined patients with Retinopathy of prematurity (ROP) and Retinoblastoma under anesthesia and provided consultation on their management with hospital doctors.

 Dr. Tong worked with the Refractionists to teach techniques of refracting pediatric patients and demonstrate orthoptics training. The doctors in the Strabismus department were eager to learn Orthoptics as a new tool that had previously never been used here.

Dr. Johnson-Tong demonstrated hands-on techniques of specialty contact lens fitting for keratoconus, pediatric aphakia and other corneal irregularities. Bringing with her donated contact lenses fitting sets, she and the Contact lens department staffs successfully fitted patients who otherwise had no other way to improve their vision.

In the afternoon, Dr. Pi and Dr. O’Hara gave several lectures to the hospital staffs. Dr. Pi started with his lecture on “Anesthesia for Pediatric Ophthalmology Surgery,” explaining some of the key physiologic differences between infants and adults, and what those mean for anesthesiologists. Dr. O’Hara then described several pediatric disorders, such as dissociated vertical deviation (DVD) and congenital glaucoma, and offered advice for treatment.
Saturday, June 16: Ho Chi Minh City Eye Hospital and Continental Saigon Hotel

Before the conference began on Saturday morning, Dr. O’Hara and Dr. Pham visited the hospital one last time for post-operative review of the four surgery cases. Dr. O’Hara offered parting advice for both the Vietnamese physicians and the patients’ parents in order to ensure a healthy recovery. As she left, Dr. O’Hara donated some toys she had brought from the US to the excited young patients.

Then, Vietnamese ophthalmologists gathered at the Hotel Continental in Ho Chi Minh City for the symposium conclusion. The symposium gathered the American visitors and at least 50 Vietnamese ophthalmologists for a program of lectures and case presentations.

The four American visitors and three Vietnamese physicians gave lectures and case presentations throughout the program, highlighting the main lessons from the busy two days at the eye hospital. The lectures were:
Case Presentation: Strabismus (Dr. Hanh)
Anatomy of Extraocular Muscles and Strabismus (Dr. O’Hara)
Case Presentation: Orthoptics (Dr. Yen)
Binocular Vision and Orthoptics (Dr. Tong)
Pediatric Ocular Tumors (Dr. O’Hara)
Pediatric Anesthesia for Eye Surgery (Dr. Pi)
Amblyopia: Current Therapies (Dr. Tong)
Pediatric Refractive Errors & Contact Lenses (Dr. Johnson-Tong)
Case Presentation: Congenital Glaucoma (Dr. Tam)
Congenital Glaucoma (Dr. O’Hara)

Monday, June 17: Hue Central Hospital

After the symposium, Dr. O’Hara, Dr. Tong, and Dr. Johnson-Tong traveled more than 600 miles (about 1000 km) to Hue for similar outreach efforts. They saw patients and gave lectures to a smaller group of Vietnamese ophthalmologists at Hue Central Hospital.

Enthusiastic responses from VN doctors

Video clip of Vietnamese doctors' reaction to the symposium:

Dr. Truyen , a pediatric ophthalmologist at the HCMC Eye Hospital, found the experience to be very fulfilling: “This symposium is very helpful so we can learn from simulations, diagnoses, and the technique being showed to you.” He said that vertical deviation surgery and interior transpositions were just some of the lessons he’s taken away from the symposium.

“From now on, I will apply what’s learned,” he said.

Dr. Truyen  also spoke about the importance of the ability to speak English in the Vietnamese medical world. “Many other doctors from other provinces come in here and we talk about new techniques,” he said. “If you have English, you can learn fully anything they teach.”

Dr. Hong Hanh, a strabismus specialist who assisted Dr. O’Hara in the operating room and translated during the Friday lectures, also appreciated the opportunity to meet with physicians from across the world.

“I like it. This is a very useful program,” she said. “We can learn and interact. American doctors are very warmful and they help us a lot in professional and surgical tips.” Dr. Hanh also gave a case presentation on strabismus during the Saturday conference.

For Dr. Nguyen, those “tips” will benefit her patients for years to come.  in the past, her strabismus surgeries have gotten  too close to the inferior rectus muscle, and so some patients’ eyes get stuck when they look out and down after the surgery. She says she will remember Dr. O’Hara’s advice during a strabismus case in the operating room, “Always have 2 millimeters away from the inferior rectus.”

The day after the strabismus surgery, Dr. Nguyen checked the patient’s progress. “The eye movement is normal and I’m very happy with that,” she said.

A rewarding experience for visiting American doctors
The experience took special meaning for Dr. Tong, who was born in Can Tho, Vietnam. In 1975, he moved to California; this symposium marked his second visit back to Vietnam. He was particularly moved by the resilience of the Vietnamese doctors and their ability to “do amazingly well with what they have,” even though that means lacking a number of equipment, such as contact lens supplies, adequate space for patients, and blood pressure monitors in the surgery recovery room.

Dr. Pi agreed: “They do so much with so little.” He was also impressed with the young patients themselves: “the kids are brave, very mature for their age.” The older children simply walked into the operating room and calmly lay down on the operating table. 

Because of VAOS, Dr. Pi said that he was more interested in the Hawaiian Eye Foundation, a VAOS sponsor.

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